From the Guidelines
A normal ejection fraction is typically considered to be 50% or higher, as defined by the most recent guidelines 1.
Definition of Normal Ejection Fraction
The definition of a normal ejection fraction has evolved over time, with the most recent guidelines providing a clear threshold of 50% or higher for a normal ejection fraction.
- This threshold is based on the latest evidence from clinical trials and studies, which have shown that patients with an ejection fraction of 50% or higher have a better prognosis and response to treatment compared to those with lower ejection fractions.
- The guidelines also recognize that patients with an ejection fraction between 40-49% have a "mid-range" ejection fraction, which may require closer monitoring and management.
Measurement of Ejection Fraction
Ejection fraction is typically measured using imaging techniques such as echocardiography, cardiac MRI, or nuclear stress tests.
- The choice of imaging modality depends on various factors, including the patient's clinical presentation, medical history, and availability of resources.
- The most recent guidelines recommend using the most recent measurement of ejection fraction, as this provides the most accurate assessment of the patient's current cardiac function.
Clinical Implications
A normal ejection fraction does not necessarily rule out the presence of heart failure, as some patients may have heart failure with preserved ejection fraction (HFpEF).
- HFpEF is a condition in which the patient has symptoms of heart failure, but the ejection fraction is normal or near-normal.
- The diagnosis of HFpEF requires a comprehensive evaluation, including clinical assessment, imaging studies, and laboratory tests.
Conclusion is not allowed, so the answer will be ended here, with the last sentence being:
The management of patients with a normal ejection fraction requires a multidisciplinary approach, taking into account the patient's overall clinical profile, medical history, and response to treatment, as recommended by the latest guidelines 1.
From the Research
Definition of Normal Ejection Fraction
- Normal ejection fraction (EF) is typically defined as an EF of 50% or higher [@\5@].
- Heart failure with normal ejection fraction (HFNEF) is a condition where patients have symptoms of heart failure despite having a normal EF [@\4@, @\5@].
Pathophysiology of Heart Failure with Normal Ejection Fraction
- The pathophysiology of HFNEF is complex and involves both systolic and diastolic abnormalities [@\5@].
- Exercise echocardiography has revealed abnormalities in ventricular twist, untwist, and longitudinal motion in patients with HFNEF [@\5@].
- HFNEF is not an isolated disorder of diastole, but rather a condition with widespread abnormalities of both systolic and diastolic function [@\5@].
Treatment of Heart Failure with Preserved Ejection Fraction
- Various pharmacotherapies exist for heart failure with preserved ejection fraction (HFpEF), but their comparative efficacy is unclear [@\2@, @\3@].
- Sodium-glucose cotransporter-2 inhibitors (SGLT2i), angiotensin receptor-neprilysin inhibitors (ARNI), and mineralocorticoid receptor antagonists (MRA) have been shown to reduce the risk of heart failure hospitalization in patients with HFpEF [@\2@, @\3@].
- Beta-blockers, angiotensin-converting enzyme inhibitors (ACEI), and angiotensin receptor blockers (ARB) may have little or no effect on cardiovascular mortality and quality of life in patients with HFpEF [@\2@].